November 2, 2001

Preop through patients’ eyes — New system improves efficiency of process

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At the hospital entrance greeters use this device to apprise the OR of patient arrivals. (photo by Dana Johnson)

Preop through patients’ eyes — New system improves efficiency of process

When surgical patients arrive at Vanderbilt for their initial clinic appointment, they’ll know more about where to park, where they’re going and what to expect when they get to their clinic. Vanderbilt has in fact begun to revamp the entire process leading up to surgery, from the point the patient is referred to a Vanderbilt surgeon to the moment the patient leaves the holding room for surgery. Among the changes, referring physicians around the region will have more information on the Vanderbilt preoperative process and will be in a better position to inform their patients about what to expect when they come to VUMC for surgical evaluation and treatment.

At a three-day retreat in July, leaders, physicians and front-line staff examined the preoperative process in full. “The retreat focused everyone on the patient’s experience,” said Dr. Dan Beauchamp, director of the Section of Surgical Sciences.

The group redesigned the preoperative process and drafted action plans now being elaborated and implemented by various preop task forces.

The preoperative visit

Among the more significant recurring preventable problems targeted in preoperative redesign are repetitive questioning of patients and delays and rework that arise when patient records gathered early in the preop process wind up missing in later stages. While certain vital patient information will continue to be updated and reconfirmed at various stages in the preoperative process, the patient’s full medical history and contact information will be taken only once at Vanderbilt. Rapid electronic archiving of patient records and patient consent, and the use of a new standardized patient information form, will help end repetitive questioning, delays and rework, in turn making for a more calm patient experience.

Patients with Web access will be able to fill out the new standardized preoperative patient information form prior to their clinic visit (market research indicates that currently half of Vanderbilt surgical patients have access to the Web). Patients without Web access will fill out the form during their initial clinic visit, either on portable touch screens or on paper forms that will be quickly scanned into StarChart, Vanderbilt’s clinical information system.

Outside test results and other medical records brought by the patient to the initial clinic visit will be scanned post-haste into StarChart. Scanning of completed patient consent forms will head off today’s frequent re-doing of consent forms on the day of surgery.

A trial of this new scanning process for outside test results, patient information and patient consent will begin soon in neurosurgery and orthopedics; a vendor will do the scanning on site.

Vanderbilt will also consider an electronic system that both informs patients about risks associated with their surgical procedure and electronically records patient consent for treatment. The system would be available over the Web and at kiosks located throughout the clinic.

Unlike today, clinics will be able to reserve the OR over the Web, allowing them to give patients at their initial clinic visit a tentative date and time for their surgery.

Fewer patients will need to follow their surgical clinic visit with a visit to a Vanderbilt preoperative evaluation center for pre-anesthesia evaluation. An algorithm performed in the surgical clinics will determine the appropriate level of preop evaluation for each patient. Healthy patients headed for minor surgery will be evaluated on the day of surgery. It’s expected that when only those patients who need more thorough pre-anesthesia evaluation are directed to the preoperative centers, unlike today, there’ll be no wait. For patients who live at a greater distance from Nashville, anesthesiology will work with the referring physician to accomplish off-site preop evaluations.

Surgical patient Internet portal

Surgical services will use the Web to provide individualized preoperative patient instructions, information about the surgical procedure, and information about the hospital and clinic. The Web package will be built as part of E3, the project to remove paper-based processes from the clinics by 2003.

The individualized instructions—medications, dietary restrictions, etc.—will take into account any diseases or conditions the patient may have, as well as any other medications the patient may be taking. The instructions will be a combination of instructions from the surgical practice and from anesthesiology, rendered free of the unsettling contradictions that occasionally arise today between these two sets of instructions.

The Web package will include a description of the surgical procedure and may also include video of the OR and of the procedure itself.

Today patients and families sometimes aren’t informed ahead of time regarding the expected length of the postsurgical hospital stay. This will be covered in the Web package, along with driving directions and schedules.

Day of surgery

At the entrance to VUH, guest services staff have begun using hand-held devices to register the arrival of surgical patients bound for the main OR. The hand-helds use radio transmission to link with the OR patient-tracking system. By immediately registering arrivals, the main OR can make optimum use of resources, adjusting the position of patients in the admitting queue as OR rooms become available.

Until recently, surgical patients bound for the third floor of VUH were instructed to follow a pattern of floor tiles from the elevator to the holding room, but today these patients are being met at the elevator and escorted to the presurgical care unit, formerly the holding room.

Previously, the tight quarters of the main OR presurgical care unit required limiting visitors to one-at-a-time per patient, and this left other family members to line the outside hallway. A waiting room for these families was created recently when Dr. Michael Higgins, assistant professor of Anesthesiology (and a leader of two preop task forces) volunteered to give up his office for this purpose. The question of building private holding rooms for the main OR will be considered when VUH pediatric units are relocated to the new Vanderbilt Children’s Hospital.

Redesign of the preoperative patient process is part of a larger effort begun early last year to improve OR efficiency. For additional information or to contribute comments and suggestions, call the OR Rapid Redesign voice mailbox, 2-0589.